Abortion Care

The procedure can be performed with either local anesthesia or deep sedation. If the procedure is done under sedation, you will be completely sedated and you will not see, hear or feel any part of the surgery. If the procedure is done under local anesthesia, you will be conscious and will receive an anesthetic. The local anesthetic will numb your cervix, lessening your pain, but you will still experience cramping and discomfort during the procedure.

To ensure your safety on the day of your appointment, you will go through a series of pre-operative assessments with the medical and counseling staff. You will have:

• Ultrasound - to determine the gestational age of the pregnancy
• Lab testing - to evaluate vital signs and to determine blood type as well as hemoglobin level
• Counseling - to address your questions and concerns about the procedure
• History and Physical - to review your medical history, current physical state and birth control options
• Billing - to make your payment using cash or insurance.

After your pre-operative assessment has been completed, you will be prepared for surgery and escorted to the operating room for the procedure. During the surgery there will be approximately 3-5 medical staff in the operating room with you (depending on your individual needs).

The procedure will begin with the physician performing a pelvic exam to determine the size and location of the pregnancy in the uterus. The doctor will then insert a speculum into the vagina so that he/she can view the cervix. The cervix is the lower end of the uterus, and is located at the top of the vaginal canal. The doctor will clean the vaginal canal with an antiseptic. Next, he/she will dilate, or open, the cervix by inserting a series of sterile metal rods, one by one, into the opening of the cervix. These rods, called dilators, gradually increase in width. Dilation for a first trimester abortion is minimal. Once the cervix is opened, the physician will be able to remove the pregnancy from the uterus. The doctor will insert a sterile, plastic, flexible tube called a “cannula” into the uterus. The cannula is attached by a tube to a machine called a “vacuum aspirator”, which creates a suction that removes the pregnancy. Once these steps are complete, the surgeon will clean the inside of the uterus with an instrument called a curette to ensure that all pregnancy tissue has been removed. The whole process takes about 5 – 10 minutes. After surgery, the patient will be monitored for about 30-45 minutes, or until she is medically cleared to return home.

At CHWC, our general protocol is that pregnancies between 12 weeks LMP and 18 weeks LMP will require a “One Day” second trimester procedure and that all pregnancies greater than 18 weeks LMP will require a “Two Day” second trimester procedure. Depending on your medical and pregnancy history, the physician may determine that, for your safety, a pregnancy earlier than 18 weeks will require a “Two Day” procedure. Prior to starting any second trimester procedure, you will go through the same pre-procedural assessment as all other abortion patients.

Prior to a second trimester abortion, the cervix is dilated through the administration of one of two medications called misoprostol (cytotec) and pitocin and/or laminaria/lamicel insertion. Laminaria are made of sterilized seaweed and look like tiny tampons. Lamicel are similar, but made of a synthetic material. The misoprotol is taken orally prior to surgery and may take several hours to work. Misoprostol is a medication administered to relax the cervix muscle so that the surgeon can dilate it easily. Pitocin is also used sometimes to help with this process and is administered through an I.V.

If laminaria or lamicel is necessary to complete dilation, they must be inserted into the patient’s cervix by the physician prior to the abortion procedure. The laminaria/lamicel act like sponges by absorbing the moisture in the patient’s vagina and expanding to gently open the cervix. This method of dilation prevents damage to the cervix by mimicking the gradual manner in which the cervix opens naturally. Depending on the gestational age of the pregnancy and the patient’s medical history, the physician will decide on the best method of dilation with misoprostol (cytotec), pitocin and/or laminaria/lamicel.

For patients that are 18 weeks pregnant or more by LMP, the physician will also administer a medication called digoxin on the first day of the abortion procedure. Digoxin is administered directly into the fetus to induce fetal demise (death). This is administered at 18 or more weeks in a pregnancy in order to prevent a live birth and also to ensure that the fetus is unable to feel any part of the abortion procedure. Medical evidence is unclear as to the exact time a fetus is developed enough to feel pain, but some studies point to a time around 20 – 22 weeks. We feel that administering digoxin is the most humane thing we can do in order to ensure that the fetus does not experience pain during the procedure.

The physician will perform the surgical abortion after dilation of the cervix is complete—this may take several hours or overnight. You will be escorted to the operating room, and the procedure will begin after the anesthesiologist administers anesthesia to completely sedate you. Once you are asleep, the doctor will remove the laminaria (if applicable) insert a speculum into your vagina, and remove the pregnancy under the guidance of an ultrasound, using vacuum aspiration (suction) and sterile surgical instruments, including forceps and curettes. The surgical procedure takes approximately 10 – 25 minutes. After surgery, you will be taken into the recovery room, where nurses will monitor you for approximately 45 minutes.

If the procedure is performed under local anesthesia, the patient will be awake and conscious during the procedure. Patients will be able to see and hear during the procedure, and will be able to remember everything that happened during the surgery. While local anesthetics can be administered differently, at CHWC, the physician will inject the anesthetic into the patient’s cervix. This will lessen the pain, but the patient will still experience cramping and discomfort during the procedure. Ibuprofen is offered after the surgery to ease cramping and pain. Breathing exercises may also be used in conjunction with local anesthetic to minimize discomfort. Local anesthesia allows women to remain alert during the process, which may be more empowering for some individuals. In addition, this method allows women to avoid some of the side effects often associated with sedation.

If the procedure is performed under deep sedation, the patient will be completely sedated, and she will not see, hear or feel any part of the surgery and will not remember anything about the surgery afterwards. This type of anesthesia is administered through an IV. While this is an optimal method for women who wish to decrease pain, it may not be appropriate for obese women or women with certain medical conditions. Our medical staff will help you determine which type of anesthesia is safest for you. Sedation may also cause side effects such as nausea, dizziness, and feeling cold. Deep sedation also takes a longer time to wear off entirely and the patient will feel drowsy for several hours or a full day. This means the patient will be required to have a friend or family member escort her home after surgery.

Mifeprex has been available as an early abortion method in the United States since September 2000, although in several other countries around the world, mifepristone and RU-486 have been legal, early abortion methods for more than 10 years. While studies have shown that various regimens for administering the medications can work safely and effectively, the FDA has approved only one regimen for administration in the U.S. While some doctor’s offices and clinics may use the FDA approved method, others may use an alternative or “off label” method which should have similar success and safety rates. Here, at the Cherry Hill Women’s Center (CHWC), we use an “off-label” method for administering a non-surgical abortion.

The non-surgical abortion is known as an early abortion method because the FDA has approved Mifeprex for use up to 7 weeks from the last menstrual period (LMP). Depending on the facility’s protocols, the pill may be offered to patients up to 9 weeks LMP. At CHWC, you may choose a non-surgical abortion to end your pregnancy if you are between 5 and 8 weeks pregnant based on your last menstrual period, live within 45 minutes of our facility and are an appropriate candidate.

• Step 1:

On the day of your first appointment, you will go through a pre-procedural assessment, which includes having an ultrasound, vital sign and blood testing, medical consultation, counseling session, and payment. Following your assessment, you will meet with the obstetrician/gynecologist who will perform a pelvic exam. The non-surgical procedure will begin when the doctor administers Mifeprex. This medication is taken orally and will stop production of the hormones necessary to sustain the pregnancy which will cause the pregnancy to detach from the uterus.

• Step 2:

24 – 48 hours after taking Mifeprex you will take an oral dose of Misoprostol. Misoprostol is a medication that induces the uterus to contract and expel the pregnancy. You can expect the first symptoms of abortion within 4 – 6 hours of taking the misopostol. You will begin to experience strong cramping and heavy bleeding. Some women say that the procedure is very much like a heavy period while other women describe the bleeding and cramping as much more intense. Please keep in mind that everyone responds to this non-surgical abortion differently.

The heaviest of the bleeding and cramping should pass within the first 48 – 72 hours. Afterwards your bleeding should then begin to resemble a normal period. You may continue to bleed and have some mild cramping for up to 30 days.

• Step 3:

You will return to CHWC for a follow-up exam which includes a urine pregnancy test and ultrasound. This is the most important part of the procedure, as this is the only way to determine if the abortion is complete and that there are no current complications. If the non-surgical abortion fails to remove all the pregnancy tissue, the physician may give you more misoprostol to expel the remaining tissue from your uterus or perform a surgical abortion. 5-8 out of 100 women will need a surgical procedure to end the pregnancy.

CHWC has experience caring for patients who have a pregnancy diagnosed with anencephaly, Trisomy 13, 18, and 21, spina bifida, hydrocephalus, Klinefelter’s syndrome, dwarfism, oligohydramnios, Dandy Walker variant, and a range of other significant anomalies. If you chose to end your pregnancy on the basis of information provided by your doctor or genetic counselor, the goal of the Fetal Anomaly Program is to assist you during this enormously difficult time in your life. Please call CHWC and ask for the Director of Fetal Anomaly Services.

Options counseling allows women to come in and speak with one of our skilled counselors about her feelings regarding her pregnancy and her options in dealing with the pregnancy including abortion, adoption and parenthood. These sessions are designed to give the patient the resources to come to her own decision without pressure from family, partner, or friends.

Post-abortion counseling is offered to our patients who feel that they need or want someone to talk to about their feelings after having a procedure at our facility. You can request counseling on the day of your procedure or you can call later to request counseling if you feel you need it.

For more information on services at Cherry Hill Women’s Center, or to schedule an appointment, please call the office at 856.667.5910 or 800.877.6331.  For more information on abortion care, you can also visit AbortionUSA.com.